• Ann. Thorac. Surg. · Aug 2020

    The Impact of a Reentry Tear After Open Repair of Nonsyndromic Acute Type I Aortic Dissection.

    • Jung-Hwan Kim, Seung Hyun Lee, Sak Lee, Young-Nam Youn, Kyung-Jong Yoo, and Hyun-Chel Joo.
    • Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
    • Ann. Thorac. Surg. 2020 Aug 1; 110 (2): 475-482.

    BackgroundThe role of a reentry tear in the descending thoracic aorta (DTA) after repair of acute aortic dissection is not well known. We therefore investigated the impact of reentry tear location on late aorta reintervention and the aortic expansion rate after open repair of acute type I aortic dissection.MethodsWe analyzed 309 nonsyndromic acute type I aortic dissection patients who were treated with a repair to the proximal aorta between 1994 and 2017. The locations of reentry tears, identified with predischarge computed tomography, were the proximal DTA in 119 patients (38.5%), distal DTA in 78 (25.2%), and abdominal aorta in 129 (41.7%). Patients who had a proximal DTA reentry tear were defined as the PDR group (119 [38.5%]), and the others were defined as the non-PDR group (190 [61.5%]).ResultsThe 15-year freedom from aorta reintervention was significantly lower in the PDR group (51.5% ± 0.7% vs 90.4% ± 4.4%, P < .001). The aortic expansion rates of the proximal DTA (7.6 ± 16.1 mm/y vs 0.1 ± 2.5 mm/y, P < .001) and distal DTA (6.8 ± 15.5 mm/y vs 0.3 ± 3.1 mm/y, P < .001) were significantly higher in the PDR group. The 15-year freedom from significant aortic expansion was significantly lower in the PDR group (34.6% ± 6.9% vs 83.6% ± 7.9%, P < .001). Multivariate analysis showed that a proximal DTA reentry tear was an independent risk factor for aorta reintervention (hazard ratio, 4.955; 95% confidence interval, 1.691-14.523; P = .004) and significant aortic expansion (HR, 4.214; 95% CI, 1.691-10.498; P = .002).ConclusionsA proximally located DTA reentry tear was associated with an increased risk of late aorta reintervention and distal aortic dilatation.Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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